THE GROWING EVIDENCE OF THE RELATIONSHIP BETWEEN OBESITY AND CANCER AND THE ROLE OF BARIATRIC SURGERY

KASSAB, Paulo; FERRAZ, Álvaro Antônio Bandeira; MITIDIERI, Anna Clara Hebling; BERTI, Luiz Vicente; SANTO, Marco Aurélio; SZEGO, Tiago; ZANON, Caio de Carvalho; CASTRO, Osvaldo Antônio Prado; FREITAS JUNIOR, Wilson Rodrigues de; ILIAS, Elias Jirjoss; MALHEIROS, Carlos Alberto; VALEZ, Antônio Carlos; CAMPOS, Antônio Carlos Ligocki; ,

doi:10.1590/0102-6720202400044e1838

Review Article - Position Paper • ABCD, arq. bras. cir. dig. 37 • 2024 • https://doi.org/10.1590/0102-6720202400044e1838 linkcopy

THE GROWING EVIDENCE OF THE RELATIONSHIP BETWEEN OBESITY AND CANCER AND THE ROLE OF BARIATRIC SURGERY

A CRESCENTE EVIDÊNCIA DA RELAÇÃO ENTRE OBESIDADE E CÂNCER E O PAPEL DA CIRURGIA BARIÁTRICA

Authorship SCIMAGO INSTITUTIONS RANKINGS

Obesity is recognized as a significant risk factor for various types of cancer. Although the incidence of some types of cancer across various primary sites is decreasing due to specific prevention measures (screening programs, smoking cessation), the incidence of neoplasms in the young population shows a significant increase associated with obesity. There is sufficient evidence to say that bariatric surgery has been shown to significantly lower the risk of developing obesity-associated cancers, which are linked to metabolic dysregulation, chronic low-grade systemic inflammation, and hormonal alterations such as elevated levels of insulin and sex hormones.

HEADINGS:
Obesity; Bariatric surgery; Neoplasms

Strength of evidence for a cancer-preventive effect of the absence of excess body fat according to the site or type of cancer
Location or type of cancer	Strength of evidence in humans	Relative risk of higher versus normal BMI (95%CI)
Esophagus adenocarcinoma	Sufficient	4.8 (3.0-7.7)
Cardia	Sufficient	1.8 (1.3-2.5)
Colorectal	Sufficient	1.3 (1.3-1.4)
Liver	Sufficient	1.8 (1.6-2.1)
Gallbladder	Sufficient	1.3 (1.2-1.4)
Pancreas	Sufficient	1.5 (1.2-1.8)
Breast, post-menopausal	Sufficient	1.1 (1.1-1.2)
Uterus (body)	Sufficient	7.1 (6.3-8.1)
Ovary	Sufficient	1.1 (1.1-1.2)
Kidney (renal cell)	Sufficient	1.8 (1.7-1.9)
Meningioma	Sufficient	1.5 (1.3-1.8)
Thyroid	Sufficient	1.1 (1.0-1.1)
Myeloma	Sufficient	1.5 (1.2-2.0)
Male Breast Cancer	Limited	Not applicable
Prostate Cancer (fatal)	Limited	Not applicable
Diffuse Large B-cell Lymphoma	Limited	Not applicable

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[1] BMI: body mass index; 95%CI: 95% confidence interval. A five-point increase in BMI has an impact on the relative risk (RR) of several cancers associated with excess weight, including cervical cancer (worldwide RR – 1.5), esophageal cancer (RR in Europe and North America – 1.48), liver cancer (European RR – 1.59), pancreatic cancer (RR in Europe, Australia, and North America – 1.14), and stomach cancer (RR in Europe and North America – 1.31)⁶⁷. Additionally, evidence suggests that obesity exacerbates several aspects related to cancer survival, including quality of life, recurrence, progression, and prognosis, while also increasing the risk of a second primary neoplasm. During cancer treatment itself, obesity is related to complications such as lymphedema in breast cancer and incontinence in prostate cancer following radical surgical resection. Even in hematologic malignancies, such as multiple myeloma, patients with higher BMI face a higher risk of death³¹.